Analysis Confirms Sulfonylurea Risks, Adds to Glitazone Debate

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The sulfonylureas as a drug class were associated with an excess all-cause

mortality risk, and treatment with some of them was followed by more heart

failure, compared with treatment with *metformin*, in a retrospective

analysis encompassing >90 000 diabetics in a British general-practice data

base [1].

" Our findings suggest a relatively unfavorable risk profile of sulfonylureas

compared with metformin. This is consistent with the recommendations of the

*American Diabetes Association* and *International Diabetes Federation*,

which favor metformin as the initial treatment for type 2 diabetes, " write

the authors, led by *Dr Ioanna Tzoulaki* (Imperial College London, UK), in a

report published online December 3, 2009 in *BMJ*.

Looking also at the thiazolidinediones (TZDs), Tzoulaki et al found that

survival was significantly better on *pioglitazone* (Actos, Takeda

Pharmaceuticals) compared with metformin and, in separate analyses, compared

with *rosiglitazone* (Avandia, GlaxoKline)--although the latter

finding's significance faded in a more fully adjusted statistical model.

Venturing into less well-settled territory, their analysis also saw no

increased risk of MI from treatment with TZDs in general or from

rosiglitazone in particular. The finding is at odds with other recent

studies that agreed with the 2007 meta-analysis from Nissen and Wolski [2]

that launched a high-profile, still-continuing controversy over the drug's

potential hazards.

Full article:

http://www.medscape.com/viewarticle/713410?sssdmh=dm1.566018 & src=nldne & uac=12164\

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Ortiz, MS RD

You know you're getting old, when Santa starts looking younger.